Domain III: Management of Food and Nutrition Programs and Services Flashcards
1
Q
Functions of Management
A
Plan
Organize
Staff
direct
control/evaluate
2
Q
Planning
A
basic function of management
1. objectives-predetermined; towards which management directs its efforts
–serve as motivators, provide direction
2. policies- general decision-making guides, boundaries within you must operate (all customer complaints will be addressed within one day)
3. procedures-chronological sequence of activities, specific guide for daily operations (how to run the dish-machine)
4. time span
5. Emergency preparedness
3
Q
short range or operational planning
A
covers period of 1 year or less; usually the operating budget; projected in days, weeks, months
4
Q
long range planning
A
up to a 5 year cycle, focus on goals and objectives (requires a mission statement of long-range vision)
5
Q
strategic planning
A
decisions about intended future outcomes, and how success is measured and evaluated
1. broad technological and competitive aspects; sets direction for organization
2. SWOT analysis: strengths, weaknesses, opportunities, threats
3. assesses the environment outside and inside the organization
4. focus strategy: targets specific, limited-size market niche
5. example of strategic goal: decrease hospital length of stay
6
Q
Emergency preparedness
A
- Table top drill involves stimulated emergency situation to test emergency plans
- Personnel should be screened, addresses and numbers updated, ID badges, orientation session, practice drills. The plan should be posted and updated, emergency numbers and warning signals listed, evacuation route posted, OSHA and HAZMAT numbers posted, location of emergency doors, supplies, menu; water safety supplies; backup storage for computer records
- Procurement, receiving, storage: MOU (memo of understanding) with vendors, list of companies that supply food, name and ID of delivery persons; delivery routes, days, times; inspect loading dock for suspicious materials
- Security: doors/windows locked when not in use; surveillance cameras on docks, security personnel
- Production and service: safe food practices followed, issued foods checked, hands washed, authorized personnel prepare and serve food
7
Q
Organizing and staffing
A
identify tasks and activities, divide tasks into positions, establish relationships among all other functions of management
8
Q
organizational chart
A
shows how the employee fits into the organization
1. shows relationship of positions and functions
2. depicts lines of authority shown with solid lines (chain of command)
3. chain of command- shows command relationship from top to lowest level
–beings with one and extends downward
–not shown: degree of authority at each level, informal relationships
4. advisory (staff) positions shown with dotted lines
–advise and support the line, but not involved in day-to-day operations
–Consultant Dietitian in a Nursing Home
5. functional-serves as both line and staff
–has limited authority over a segment of activity because of specialized knowledge, units are defined by the nature of the work. The responsibility of purchasing may be given to a head purchasing agent who oversees that function in all departments. Efficient use of resources
6. span of control-number of individuals or departments under the direction of one individual
–narrow span- more levels are created, need more managers, needed with newly hired personnel
–wide span- fewer levels and fewer managers are needed, used with highly trained and highly motivated workers
9
Q
Staffing patterns
A
- acute care conventional: 17 min/meal or 3.5 meals/labor hour
- extended care facilities: 5 meals/labor hour
- cafeteria: 5.5 meals/labor hour
- school foodservice: 13-15 meals/labor hour
- these reflect averages and are only guides
- when determining meals served, consider meal equivalents
(If it takes as much labor to produce 6 nourishments as it does 1 meal, then 6 nourishments are equivalent in labor to 1 meal) - Meal equivalent is a measure of productivity defined as the amount of all food sales divided by the average cost of a typical (prototype) meal
10
Q
work schedules
A
usually include an 8-hour work day, a 30-min lunch break and one or two 15-min work breaks
1. master- serves as overall plan; days on and off, vacations; basis for developing weekly schedules
2. shift- staffing patterns for a particular operation; positions and hours worked, number of days worked per week, relief assignments
3. production schedule- time sequencing of events required to produce a meal; employee assignments and menu items; quantity to prepare and the timing (what to do when)
11
Q
FTE-full time equivalent
A
- absolute FTE=minimum number of employees needed to staff the facility; counts productive hours (hours actually worked)
- adjusted FTE also takes into account the benefit days and days off
- FTE/day: labor hours worked/day/8 hour normal work load
- FTE/week: labor hours worked/week/ 40 hour normal work load
- FTE/year: labor hours worked that year/2080
*Labor hours worked includes full-time and part-time workers
12
Q
Relief workers
A
- Approximately 1.55 employees are necessary for everyday coverage of full-time positions. Full-time employees generally are available an average of only 236 days per year because of days off and benefit days (129 days)
- to determine the actual number of employees needed, multiple the number of full-time positions by 0.55 (129/236) to get the number of relief workers needed to cover 365 days per year
–if you have 20 full-time positions: 20x0.55=11 relief employees
–employees + relief employees = total number required (20+11=31)
–another approach: Multiply 1.55x# of employees (20x1.55=31) - Hospital food service positions cover a 7-day week. Employees work 5 days and have 2 days off. A relief worker covers those 2 days off and can also work a 5-day week. So, a relief worker can cover the “days off” of 2.5 full-time workers each week (5/2=2.5)
13
Q
Productivity
A
the efficiency with which a production or service activity converts inputs into outputs, expressed as ratios
1. inputs (resources): labor, money, materials, facilities, energy
2. outputs (units of service): meals, patient days, consults
3. labor minutes worked per day, trays per minute, consults per labor hour
4. to increase productivity, increase the output or decrease the input
14
Q
work simplification procedures
A
increase productivity and decrease costs
1. purpose: eliminate unnecessary parts of the job and those that add no value
2. looks at SMALLEST parts of the job (hand movements, steps taken)
3. examples
–motion economy: reduce motions and time required (use shortest and straightest routes to move materials. Movement should be: simultaneous, symmetrical, natural, rhythmic, habitual)
–occurrence sampling: observe random samples (intermittent observations) to determine percentage of time working or idle
–pathway chart or flow diagram: scale drawing showing path of a worker during a process
–operations chart: movements of hands; reduces transportation and re-plan work areas. Use both hands simultaneously and effectively
–process chart: steps involved in process using symbols
–cross charts: efficiency of equipment placement, studies work motions, shows number of movements between pieces of equipment
15
Q
Directing
A
- coordination links activities of various departments within the organization
- delegation is the distribution of work to qualified people
- communication-transmitting and receiving information to bring about a desired action
16
Q
Delegation
A
- manager must have a clear understanding of what they want done, give specific instructions, motivate, provide training, require complete work, establish adequate controls
- barriers to effective delegation-manager’s reluctance to delegate (feel they can do better themselves, feel a loss of power, may be too disorganized to plan ahead, lack of confidence in subordinates)
- delegate duties to the lowest competent level
17
Q
Communication
A
- transmitting and receiving information to bring about a desired action
- feedback (response)tells you if the correct message has been received
- barriers: words not mutually understood, poor voice quality, illegible handwriting
- listening skills are essential
18
Q
organizational communication channels (directions on the organizational chart)
A
- downward: from Department Head down through the ranks of workers (chain of command), use procedure manuals, policy statements
- upward: from workers up to the Department Head; open-door policy, suggestion boxes, grievance procedures
- horizontal: between departments (Nutrition and Nursing), or between production and service within the Nutrition Department
- diagonal: minimizes time and effort expended in organizations; between functions diagonally placed (ordering clerk in foodservice sends requests directly to purchasing department, not through food service channels)
- informal channel (grapevine): meets social needs of group
19
Q
Maslow’s hierarchy of needs
A
determinants of behavior, motivated by the desire to satisfy specific needs
1. Basic needs
–physiological (survival needs)-food, clothing, shelter (pay, benefits, working conditions, schedule)
–security and safety-insurance, retirement plans, job security
2. Higher human needs (motivators)
–social (organized activities), belonging, acceptance, affiliation
–self-esteem (job title, praise, rewards, promotions) recognition
–self-realization, self-actualization (realizing your potential growth using creative talents); advanced training, job enrichment
3. When the basic needs are met, then the higher needs, become motivators
20
Q
Herzberg’s two-factor theory
A
motivation and maintenance approach
1. maintenance (hygiene) factors (satisfiers, dissatisfiers)
–if present and perceived as good, satisfiers
–if lacking or perceived as negative, dissatisfiers will interfere with work
–do not produce motivation, but can prevent motivation from occurring
–fair wage, insurance, retirement benefit, supervision, schedule, working conditions, interpersonal relationships on the job
–maintain minimal level of need satisfaction
2. motivators- call forth energy and enthusiasm, job enrichment
–achievement, personal accomplishment, recognition, responsibility, participation in decision-making, opportunity to growth and advance
21
Q
McClelland’s theory
A
suggests that all people have three needs: the need to achieve, need for power, and a need for affiliation
1. the achievement motive is a desire to do something better or more efficiently. People with this need tend to gravitate towards sales and management positions. They are task oriented and can manage themselves
2. the need for affiliation is the desire to be liked by others, joins groups
3. those with a need for power enjoy competition and seek confrontation
22
Q
MacGregor
A
attitude of the manager toward employees has an impact on job performance (based on manager’s assumptions as to how employees view work)
1. Theory X: people inherently dislike work and will avoid it if possible; authoritarian, work-centered; workers prefer to be controlled and directed by pressure; motivation through fear; negative, autocratic
2. Theory Y: work is as natural as play or rest; management should arrange conditions so workers can achieve goals by directing own efforts; positive, participative
23
Q
Hawthorne studies- Western Electric- Elton Mayo
A
- if you involve people in the process, they become more productive
–productivity due to: employees were given special attention, were involved in an interesting experience, and were well-treated by supervisors
–work breaks increased productivity - placebo effect (special attention improves behavior)
24
Q
Expectancy theory-Beer, Vroom
A
- rewards serve as motivators only under certain circumstances
- employees must believe that effective performance leads to certain rewards
- employees must feel that rewards offered are attractive
- Path-Goal Theory focuses on leader’s effect on employee’s motivation to perform. Motivation to behave in a particular manner is the result of an expectation that a behavior will result in a particular goal and how strongly a person desires the goal. Do they value the reward offered?
25
Leadership styles in decreasing order of control
1. autocratic- demands obedience, most control, full responsibility, crisis control
2. consultative- asks for input, but makes major decisions alone
3. bureaucratic- by the book, follows procedures to the letter
4. participative- emerging trend in management. encourage workers to participate in decision-making. uses quality circles: small group of employees who meet regularly to identify and solve problems
5. democratic- guides and encourages the group to make decisions
6. free rein (laissez-faire)- least control, allows group to make decision
26
Leadership Grid-Blake, Mouton
1. plots leader's concern for people (employees) vs their concern for production
2. scale of 1 to 9; 1 is low concern, 9 is high concern
1,9 production, people: Country club management: employee-centered; seeking approval and acceptance; comfortable, friendly atmosphere
9,9: Team management: high concern for both people and production; common stake in purpose
1,1: Impoverished management: exert minimum effort to get work done; desire to hang on, indifferent; low concern for people and production
9,1: Authority, obedience, autocratic: focus on production, managing tasks; domination, mastry, control; people are commodities like machines
5,5 Middle-of-the-road management
27
Likert-management of conflict
1. four basic systems of organizational leadership
--exploitive, autocratic: job-centered, makes all decisions
--benevolent, autocratic: job-centered, minor decisions made by workers
--consultative: employee-centered, gain some confidence
--participative: employee-centered, trust and responsibility
2. participative: most effective; employees worked under general supervision, the boss delegated authority, and it was employee-oriented; decision-making spread evenly throughout the organization; full involvement of employees in setting goals making job-related decisions
28
Peter Principle
may promote someone to a level of incompetence
29
contingency and situational leadership
responds to external environment
Methods that are highly effective in one situation may not work in another.
Results differ because situations differ. Management must identify which techniques will work in a particular situation at a particular time
30
Leadership continuum: Tannenbaum and Schmidt
Developed continuum or range of possible leadership behaviors. Each type of behavior is related to the degree of authority used by the manager and the amount of freedom available to subordinates in reaching decisions
Tells decision->Sells decision->Discusses decision->Asks for input on decision->Collaborates on decision->Delegates responsibility for decision
Manager may use a variety of approaches as the situation requires. A manager who generally involves others in making decision, must take charge in a crisis
31
Contingency approach: Fielder
In both highly favorable and highly unfavorable situations, a task-oriented leader is more effective (the group is ready to be led)
In moderately favorable situations, a relationship-oriented leader tends to be more effective because cooperation is more successful than task-oriented leadership
32
Leadership effectiveness model: Hersey, Blanchard, Johnson
Readiness of followers and recommended leadership styles to use for each.
Readiness: desire for achievement, willing and able to accept responsibility, skills relevant to task
Leadership style: Tell, Sell, Participate, Delegate
Low readiness: Tell
Low to moderate readiness: Sell
Moderate to high readiness: Participate
High readiness: Delegate
How you lead depends on who you are leading and their ability to follow
33
reciprocal approaches focus on interactions among leaders and their followers rather than on characteristics of the leaders themselves
transactional vs transformational leadership-how leaders and followers influence each other
1. transactional: clarifies roles and responsibilities; uses rewards and punishments to achieve goals (top of control list, autocratic)
2. transformational: agents of change, participative
--inspire followers to become motivated to work towards organizational goals rather than personal gain; builds on and extends transactional leadership; cultivation of employee acceptance of the group mission
34
Management theories: traditional or classical
1. formal structure that organizes and administers the work activities
2. coordination is main responsibility of management
3. focus on tasks, structure, authority
4. scalar principle- authority and responsibility flow in a direct line vertically from the highest to lowest echelons: clear and unbroken lines
5. unity of command-each is accountable to only one superior
6. criticisms-too mechanistic; job-focused and impersonal; doesn't see group interactions and decision-making processes
35
Human relations (behavioral) theory
1. uses behavioral sciences, workers exist in social groups
2. employee participation in decision-making is essential
3. improves morale and productivity
4. Theory Z- (Ouchi) the value of the company is the people (everyone who will be affected by a decision is involved in making the decision (consensus decision-making)
36
Management theories: systems approach
1. system is an organized whole composed of interdependent parts called subsystems (classified according to their purpose: procurement, production, distribution and service, safety and sanitation)
--subsystem: complete system within itself that is part of a larger system (foodservice is a subsystem of the hospital, production is a subsystem of the foodservice department)
2. open system interacting with external forces; change in one part affects many other parts
3. management approach to considering the entire organization when making decisions or allocating resources
4. major components of a system: input->transformation->output
--the process of transforming inputs into outputs involves linking (decision-making, communication), managing (plan, organize, staff, direct, control) and building function subsystems (production, distribution, service)
37
Characteristics of open systems (effective and efficient)
interdependency of parts: each part affects performance of other parts leading to integration and synergy. view as a whole, not as isolated parts
Integration: parts are blended together into a unified whole
Synergy: units working together may have greater impact than each operating separately
Dynamic equilibrium: steady state, continuous response and adaptation to environment
Equifinality: same or similar output can be achieved by using different inputs or by varying the transformation process (various alternatives may be used to achieve similar results)
Permeability of boundaries: allows system to be affected by changing environment
Interface: where two systems or subsystems come in contact with each other
38
Scientific management-Taylor
1. work-centered- workers must work at fastest pace possible and at maximum efficiency; systematic approach to improving worker efficiency
2. structure work situation to minimize motivation needed by supervisor
3. find the best way of performing tasks
4. focus on physical aspects of the job (assembly line, manufacturing)
39
Management by Objectives MBO-Druckeer
1. type of democratic management that provides control from within
2. establish performance goals and objectives with employees
--gives higher incentive value
--overall control achieved through self-control by employees
--management stresses accomplishments and results
3. participative leadership
40
Controlling/evaluating
measure present performance against standard performance
1. determine whether goals have been reached
2. ongoing process
3. shows strengths an weaknesses, solves problems
4. steps
--establish qualitative and quantitative standards (what is expected to happen)
--measure performance
--compare to standard
--take corrective action
41
Managerial Skills
1. technical (techniques, procedures)- understanding of and proficiency in a specific kind of activity. Most important at lower levels of management
2. human-ability to work effectively as a group member, interpersonal; important at all levels but imperative at lower levels of management
3. conceptual-ability to see organization as a whole; importance increase at higher ranks of management
4. hard skills can be taught, soft skills must be developed and nurtured
42
Managerial Roles
1. informational
--monitor: constantly searching for information to become more effective
--disseminator: transmits information to subordinates
--spokesman: transmits information to people inside and outside
2. interpersonal
--leader: responsible for work of the staff, hiring, training
--liaison: dealing with those inside and outside the organization
3. decisional: entrepreneur, disturbance handler, resource allocator, negotiator
43
Steps in problem solving
recognize and analyze problem
determine workable solutions
gather data
choose solutions
take action
follow-up the action
44
nominal group technique-Delbecq (generate innovative, creative ideas)
1. more structured and controlled than an ordinary brainstorming group
2. has authoritative leader, controlled interactions, closely focused goals, rigid enforced procedures, responses strictly controlled by leader
3. often sit in horseshoe formation; silent generation of ideas by participants
4. round robin reporting-leader records ideas
5. group RANKS items in priority order; vote for final decision
45
Delphi technique (consensus of experts)
1. designed to probe expert minds in a series of written interviews from which some consensus is sought
2. participants do not meet
46
Cause and effect (fish) diagram-what influences the outcome?
1. focuses on different causes of a problem; categorizes related factors to make their influence more observable
2. what are the causes of the effects (results) you are seeking?
3. series of connected arrows, each representing an important factor
4. technique to increase worker involvement in decision-making
47
Pareto analysis, bar chart
illustrates the relative the importance of problems
1. work on the tallest bar or problem that occurs most frequently; correcting the "vital few" problems will have the greatest impact on quality
2. Most effects have relatively few causes
80-20 rule: 80% of a given outcome results from 20% of an input (80% of sales come from 20% of customers)
48
Queue-queuing theory
1. develops the relationships involved in waiting in line
2. used in analyzing flow of customers in a cafeteria-balance cost of waiting lines with the cost of preventing waiting lines through increased service
49
Conflict resolution
Conflict is inevitable, sometimes necessary for the organization to survive and often leads to solutions. The task of a manager is not to suppress or resolve all conflict but to manage it to minimize its harmful aspects and maximize its beneficial aspects
50
Change management
1. in the organizational change theory model, the leader recognizes need to make a change, then inspires followers to move towards change
2. change agents serve as catalysts for change
3. successful change requires that you unfreeze the status quo, change to a new state, then refreeze to make the change permanent (prepare for change, manage i, reinforce it)
51
Influence
action that will cause a change in behavior or attitude of another
52
Power
ability to exert influence
1. reward power: ability to reward another for carrying out an order, give incentives, praise to reinforce certain behaviors
2. coercive power: negative side of reward power, ineffective in motivating behavior, may create resistance; ability to punish another for not carrying out requirements; used to maintain minimum standard of performance
3. position (legitimate) power: subordinate acknowledges that the influencer has the right to exert influence due to position (job title)
4. expert power: belief that influencer has some relevant expertise that the subordinate does not; provides credibility; viewed as competent
5. referent power (personality, charisma): based on desire to identify with or imitate the influencer, how well you are liked
Expert and legitimate powers are important for compliance
Expert and referent powers are related to subordinates' performance and satisfaction
53
Accountability
responsible to oneself, and organization oor to the public
54
Responsibility
obligation to perform an assigned activity, or see that someone else performs it
55
Managerial attributes that distinguish successful organizations from others
1. have a bias for action: fix it, do it, solve it
2. be close to your customers: learn from them
3. autonomy-be a risk taker: try new ways to get the job done
4. productivity through people: treat with respect and dignity
5. management should be hands on and value driven: explain your value system to your employees
56
Managing a diverse workforce
A multicultural workforce should value, encourage and affirm differences and diverse cultural modes.
Address incidences of prejudice and provide diversity training to increase awareness and acceptance of differences among employees
57
Emotional intelligence
the extent to which a person is in tune with their own feelings and the feelings of others. Involves skills of self-awareness, communication, empathy and self-regulation of emotions into appropriate behavior
58
Unemployment compensation
insurance against loss of income
1. must be employed for specific time, able and willing to work, unemployed through no fault of their own; employers pay tax on payroll
2. each state has own laws that define benefits in accordance with minimum federal standards
59
Workman's compensation
administered by state
1. insurance covering employers' liability for the costs of any accident incurred by an employee in connection with their job
2. must furnish a safe place to work, competent supervision, instructions
60
National Labor Relations Act-Wagner Act 1935
1. guaranteed right to organize and join labor unions
2. gave union the right to be the bargaining agent
3. created the National Labor Relations Board NLRB
--listens to claims of "unfair labor practice"
61
Taft Hartley Labor Act-Labor Management Relations Act 1947
1. balanced powers of labor and management; amended Wagner Act
2. outlawed the closed shop; limited union shop to one year
3. government can obtain injunction against strikes that endanger national health or safety
4. specified unfair labor practices of the union
62
Landrum-Griffin, Labor Management Reporting and Disclosure Act 1959
bill of rights for union members; regulates internal union affairs
63
Civil Rights Act 1964
1. prevents discrimination on basis of race, color, national origin; prohibits sexual harassment
2. overseen by the EEOC (Equal Employment Opportunity Commission)
64
Equal Employment Opportunity Act 1972
prevents discrimination in employment based on race, color, religion, sex, national origin, political affiliation, overseen by EEOC
65
Fair Labor Standards Act 1938
1. may be called Minimum Wage or Wage Hour Law; set minimum wage
2. for overtime work (over 40 hours in 1 week) must pay time and one-half
3. minimum wage-listed at Bureau of Labor Standards
4. amendment-Equal Pay Act 1963-prohibits discrimination on basis of sex
5. donated (tolerated) time-compensate-must be paid
6. child labor laws regulate work hours and duties of children; in food service, students can handle and clean cutters and slicers only if enrolled in food-related programs
7. occupations EXEMPT from minimum wage and overtime requirements: executive, administrative, professional, outside salespersons
66
Age Discrimination in Employment Act 1967
prevents discrimination due to age
67
Family and Medical Leave Act 1993
1. applies to public agencies and private agencies employing >50 workers
2. up to 12 workweeks of unpaid, job-protected leave during any 12 months for: birth or placement of a child for adoption, to care for an immediate family member, or medical leave for a serious health condition
3. when you return you are guaranteed an equal job, but NOT the same job
68
Americans with Disabilities Act 1992
1. covers employers with 15 or more employees
2. must provide "reasonable accomodations" -remove barriers, have wide aisles (36") and doors (32"), install ramps, lower shelves and phones, rearrange tables and chairs, flashing alarm lights
3. to comply, job descriptions must specify "essential" job functions
69
HIPAA Health Insurance Portability and Accountability Act 1996
allows employees to transfer coverage of existing illness to a new employer's insurance plan
70
Social Security Act 1935
insurance program to protect employees against wage loss from retirement, unemployment or disability
71
NPI
National Provider Identifier
10 digit identification number for providers and practitioners of health care service. Used in standard transactions, such as in coordination of benefits between health plans, in healthcare claims, medical records
72
NCQA
National Committee for Quality Assurance
Credentialing is the process used to assess and verify the qualifications of a healthcare provider. Many insurance companies require RDNs to become credentialed in order to provide services for their members and in order to pay claims
73
CAQH ProView
an online credentialing portal that a provider can elect to share with multiple health plans or payer organizations. It eliminates the need for multiple insurance credentialing submissions
74
Licensure
A state agency issues to individuals who meet specified qualifications to practice a particular profession. Licensing statutes for dietetics and nutrition always include a title protection provision, which is designed to prevent unlicensed individuals from holding themselves out to the public as Dietitians, Nutritionists, or using other titles as specified in the statute
75
Check-off
the deduction of union dues from pay
76
Shops
union shop- must join after being hired
open shop- can join union or not
closed shop- must be member of union first before hiring
union and closed shops are illegal in public employment
agency shop- all workers must pay agency fee, but not required to join union
77
Right to work laws
illegal to fire an employee who refuses to join a union even if contract has a union shop clause
78
Protection against unfair union practices
1. cannot force employees to join unless union shop exists
2. cannot pressure employers to force employees to join, or discriminate against those who don't join
3. cannot refuse to bargain collectively with employer, engage in secondary boycotts, charge excessive fees
79
Protection against unfair employer practices
1. cannot interfere with formation or administration of labor organizations; cannot threaten employees or ask them about their union activities
2. cannot discriminate against employees in hiring or tenure because of union activity or because they have filed charges against the company
3. cannot interfere with right to bargain collectively; cannot refuse to bargain
80
Employee rights
1. may join together to bargain as a group
2. can strike for better working conditions
3. can join union whether or not it is recognized by management
81
Union/shop steward
an employee who represents fellow employees as the union representative
--the steward does not get extra pay for serving as steward
82
collective bargaining
one person represents a group of people to bargain with the employer
1. strategies: get opposition into a good frame of mind, make "blue sky" demands or ask for twice what you expect to get, then bargain down
2. steps in order
--bargaining between union steward and management
--if that fails: mediation-neutral person helps settle differences; decision not binding
--if that fails: arbitration-hearing to dissolve a dispute during an impasse; decision is usually binding. FINAL step in bargaining
3. unions can negotiate working conditions, vacations and holidays, but not personnel requirements or strategic initiatives
(management must be present at bargaining sessions)
83
injunction
court order to prevent someone from doing something
84
job analysis
studies all aspects of the job, done by worker and their supervisor
--conducted first to collect information for job description
85
job description
reflects required skills and responsibilities
--matches applicants to job, orientation and training, employee appraisal
86
job specification
duties involved, conditions, qualifications (education, experience); written for each job
--used in selection and placement of employees (hiring)
--does not have detailed information as to what to do or time involved
87
recruiting
locate most qualified person for job
1. sources; internal (promotions, transfer, rehire), external (ads, agencies, unions)
2. Fair Employment Practice Law (adopted by states) -makes it illegal to ask about a candidate's race, religion, sex, national origin, age, marital status, or if they have children (after hire, can ask). Check with personnel department regarding restrictions
3. selection process: application, screening
--compare skills, knowledge, education with job requirements
--pre-employment testing, background and reference checks
--types of interviews
----structured (directed): use checklist or preplanned strategy; gives same information on all; minimizes personal biases
----unstructured (non-directed): no definite checklist; more participation from applicant; "Tell me about your last job"; sales, counseling, management
88
Orientation and training
1. work schedule-hour by hour-training-tasks and time
2. job breakdown-what to do and how to do it-no time limits
3. job enlargement-more similar tasks to alleviate boredom
4. job enrichment-upgrades job by adding motivating factors
--increases number of tasks and control the employee has over the job
--Maslow and Herzberg motivator (advanced training)
89
Promotion
to a job involving higher pay, status, performance needs
1. can serve as an incentive for improved performance
2. basic criteria-merit, seniority
3. may cause resentment in those bypassed
90
transfer
to another job at approximately the same level with basically the same pay, status, performance requirements
1. permits placement of employees in jobs where need for their services is greatest, or in jobs they prefer
91
separation
either voluntary or involuntary termination of an employee
1. an exit interview can help identify personnel related problems
92
compensation
1. salary-earnings of managerial and professional personnel
2. wages- hourly earning of employees covered by the Fair Labor Standards Act
93
benefits
1. statutory-payment required by law to ensure in event of unemployment, injury or death (must be provided)
2. compensatory-benefits or pay for time not worked
3. supplementary- life and health insurance
94
Disciplinary action/grievances: non-unionized vs unionized
non-unionized: grievances are settled informally by employee and supervisor
unionized: the contract states a written formal grievance procedure
95
Disciplinary action
steps taken to correct undesirable behavior
1. oral warning: discuss nature, cause, corrective actions; temporary in record
2. written warning: repeat violation of as first action if warranted; permanent in employee record
3. suspension: forced leave of absence without pay; permanent record
4. dismissal
96
Positive discipline practices
Consistency *key element*
allows an employee to feel that any other employee would receive the same discipline for committing the same offense. Disciplinary action is the result of an employee's behavior and not personality conflicts.
Focus on behavior, on observations, and provide alternatives. Documentation on employee behavior includes conduct, performance, appearance, and work availability, which are a part of progressive discipline.
a. use punishment as a last resort; punishment must fit the crime
b. the goal is to correct the behavior and save the employee
c. be sure employee is aware of the severity of the problem as well as organization's standards (was the employee properly trained)
d. corrective discipline should be meted out in private
e. compare the employee's performance with department standards rather than to another employee
f. to reprimand constructively, show the employee how to improve their pperformane
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Best use of an employee evaluation
to improve their performance by providing feedback
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criteria
evaluative dimensions against which an employee's behaviors are measured; performance expectations that the employee strives to attain
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merit rating
scales with assigned point values
100
checklist
rater records performance, does not rate the performance
--uses list of questions or statements to be answered yes or no
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critical incident
record incidents of positive and negative behavior
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self-assessment
employee may become more involved and committed; employee participation may help clarify their role and reduce role conflict
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obstacles to effective appraisals
1. halo effect: judge on most noticeable positive trait
2. leniency of error: rate everyone higher than they deserve
3. error of central tendency: rate everyone as average
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organizational culture
the shared philosophy, beliefs, expectations and attitudes that hold an organization together
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to develop a good relationship between management and staff
1. have a written mission statement
2. have integrity and build trust
3. train workers well and reward good performance
4. find ways to have fun, at work and outside of work
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labor turnover rate
of employees (separated) terminated/total positions in department x100
high labor turnover rates result in higher labor costs (replacement, hiring, training)
Goal: low turnover rate
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Cultural humility
involves the ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the client/employee
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Cultural competence
the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including the tailoring of health care delivery to meet patients' social, cultural and linguistic needs
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Inclusion
the intentional, ongoing effort to ensure that diverse people with different identities can fully participate in all aspects of the work of an organization, including leadership positions and decision-making processes. Create a more level playing field on which to compete and equal access to opportunities and information
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Cultural sensitivity
being aware of similarities and differences among various cultures as you engage in active communication with other communities
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Diversity and inclusion
encourage diversity and inclusion by striving to recognize, respect and include differences in ability, age, creed, culture, ethnicity, gender, gender identity, political affiliation, race, religion, sexual orientation, size and socioeconomic characteristics in the nutrition and dietetics profession
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Purpose of budgeting
gives manager a basis for CONTROL-estimate of future needs
1. must be flexible and adjustable according to changes
2. usually reviewed monthly
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Operating budget
1. forecast of revenues, expenses, and profit for a specific period of time
2. first step: forecast sales or revenue (income) portion
3. then budget expenditures (labor, food, operating expenses) related to the projected level of revenue
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Cash budget
1. projects revenue and expenses, showing inflow and output of cash
2. purpose is to determine if funds will be available when needed
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Capital budget
plant facilities, equipment, cost of improvements and repairs (service, maintenance contracts), expansions, replacements, long term
1. includes expenditures whose returns are expected to last beyond one year
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Pro forma statement
hypothetical
projects expected income, expenditures and profit
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Traditional (incremental, baseline) method to establish line items within the budget
uses existing budget as a base and projects changes for the ensuing year in relation to the current budget
1. usually begins with this year's expenses plus an inflation factor
2. control oriented
3. prepared at one level of sales or revenue
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zero-based budget (ZBB)
NOT this year's expenses plus an inflation factor
1. begin at 0. Must justify each expense
2. example: PBBS- Planning, Programming, Budgeting System
--past dollar allocations are NOT the basis of projections
3. planning oriented
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Fixed budget
prepared at one level of sales or revenue (no expected major change in patient or customer count during the year)
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Flexible budget
adjusted to various levels of operation with varying levels of sales or revenue throughout the year (changes in patient or customer count)
1. closing a floor for renovation
2. gives dollar range for low to high levels of predicted activity
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Performance budget
details what it costs to perform an activity (how much to supervise the trayline)
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Indirect (fixed) costs
not affected by sales volume (number of people served), not directly evident in day-to-day activities, required for business to exist even if it produces nothing, cannot be readily changed
1. rent, taxes, interest on debt, insurance, depreciation
2. stay fixed within a range of sales volume
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Depreciation
costs associated with the acquisition and installation of a fixed asset are allocated over the estimated useful life of the asset
1. straight line depreciation- gives ANNUAL depreciation; (value of the equipment (cost) - salvage value)/# of years of useful life
2. Accumulated depreciation is total depreciation up to a given date, subtracted from the original cost of the item. Included in fixed assets
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Direct, variable, flexible costs
varies directly with changes in sales (revenue); directly involved in service to customer
china, silver, food, uniforms, laundry, repairs, benefits
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Semi-variable costs
both a fixed and variable component
1. a portion of the cost will remain fixed regardless of changes in sales volume
2. labor, maintenance, utilities
3. these are divided into fixed and variable components before doing break-even analysis
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sunk costs
already incurred and cannot be recouped by a new decision or alternative; cost involved in studying merits of a new computer
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differential costs
amount of increase or decrease in cost when you compare alternative choices; difference in costs between two delivery systems
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Resource allocation
efficient allocation of people, materials, and equipment to meet the needs of the operating system (can lead to cost savings). The CPM, Critical Path Method, helps plan and control an operation. It identifies the most critical activities, to best allocate limited resources.
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Food costs
most readily controlled item, subject to greatest fluctuation
1. menu planning-most important
2. types of service- selective menu reduces waste and cost
3. purchasing methods- group buying reduces costs
4. receiving control- weigh in and check items against invoice
5. storage and production control- edible portion (EP) vs As purchased (AP)
6. standardize portions to control costs and for customer satisfaction; keep records of employee meals
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Labor costs
less controllable than food costs
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Operating costs
12-18% of budget
utilities (electricity), laundry
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Accounting principles
1. cash basis-recognizes a transaction at the time the cash is taken in or released
2. accrual basis-recognizes revenues when earned and expenses when incurred (regardless of when the actual cash is received or dispersed)
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general ledger
records and reports transactions categorized by account numbers. Summary of all expenses and revenues for the month by category (meat, fruit, dairy).
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income statement, profit and loss statement, revenue and expense statement
shows operating results over a period of time (dynamic)
--presents the income (revenue), expenses and profit (or loss or break-even) over the course of the budget period
--analyzes operational effectiveness
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balance sheet
shows financial condition as of a particular date (static)
1. lists assets (good and products owned)-cash, inventory, accounts receivable (amounts owed to you)
2. lists liabilities-amounts owed to others
3. assets=liabilities+capital (equity, owner's interest)
4. analyzes operational effectiveness. Quick way to view financial condition
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financial ratios
use of formulas to analyze an organization's financial position
1. formulas use data from financial statements
a. compares organization with similar ones
b. compares ratios with those projected or with preceding ratios
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Liquidity ratios
assess ability to meet short term debt (pay bills when due)
1. current assets and current liabilities (current: within 12 months)
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Net worth ratios
assess ability to meet long term debt, solvency
1. total assets and total liabilities; debt to asset ratio
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Turnover ratios (asset management)
shows current effectiveness of inventory control; are you efficiently using the assets to produce more income?
1. inventory turnover rate: cost of ales (food cost or COGS)/average inventory cost
(COGS: cost of goods sold)
2. Measures how often an inventory is consumed and replenished.
3. A turnover rate of 2-4 times per month is often desirable
4. High ratios indicate a limited inventory is being kept; low ratios indicate large amounts of money are tied up in stock
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Daily food cost report (food cost percentage)
what percent of the income was spent on the food sold
daily food cost/daily income=food cost percentage
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Food cost per meal
food cost per month/# meals per month
1. food cost=food purchases plus foods removed from inventory (beginning inventory minus ending inventory, plus food purchases)
2. to determine: need # meals served, food purchases, foods removed from inventory
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Profit margin
most commonly used assessment of overall financial efficiency
1. reflects the portion of sales volume remaining after paying all expenses
net profit (profit after ALL expenses have been paid)/sales dollars (revenue)
2. revenue includes income from patients, cafeteria sales and catering sales
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Cost of sales
cost of the raw food and beverage sold (COGS)
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Gross profit
profit shown after deducting raw food and beverage (cost of sales) from sales (revenue)
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Net profit
profit shown after ALL expenses have been deducted from sales
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Payback period
1. determines the length of time it will take for the cash inflows from a project to equal the initial cash outlay (how much time it will take for an investment to pay back the organization for the investment)
2. Add up the costs of the service
Add up costs saved by using the new service
Divide costs of service by dollars saved
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Marketing analysis
1. Process of identifying a need, assisting potential clients in recognizing that need and filling that need
2. Marketing channel-exchange of ownership: producer, processor, distributor, supplier, customer
3. the product or service is anything you offer in exchange for money or something else of value
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Market niche
FIRST STEP- identify a need that is not being filled
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Marketplace
where service will be offered
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market segmentation
divide market into groups of people with similar product needs
1. demographic variables: age, gender, race, education, income
2. geographic variables: urban, suburban, climate, resources, cultural values
3. psychographic: social class, lifestyle (what is important to them and their mode of living), motive (the reason the customer makes a purchase)
Innovators: high income, high self-esteem
Makers: lower income, focus on self-sufficiency, family-oriented
Achievers: successful individuals, higher incomes
Experiencers: young, impulsive, variety-seekers
4. behavioristic: occasions, loyalty, purchase volume
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Positioning statement
how would you like the marketplace to view your product
152
Decide on the target market
group of people or places with similar wants or needs with the potential for purchasing your product
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marketing objectives
quantifiable, attainable goals
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marketing strategy
route chosen to reach goals
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Product mix
group of items you will offer
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Marketing mix
Product: good, service, idea (signature brands refer to unique items your business has developed)
Place: where it is offered
Price
Promotion: to increase or renew awareness, short term
--publicity, news releases-provide info about your products to target market
--direct mail packages-promotes services or products to target market
--paid ads-buy space; personal visits-good as follow-up to direct mail
--public visibility, communication with those in your referral network
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Social, business, service marketing
1. social-use of marketing principles to advance a social cause, idea or behavior
2. business-filling customer's needs or desires
3. service marketing characteristics: intangible (performances, not products), inseparable (produced and consumed at the same time), perishable (cannot be stored for later use), heterogeneity (variation in performance of people)
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Breakeven point
point at which sales revenue (income) will exactly cover fixed and variable costs
1. BE = Fixed Costs/(selling price-variable cost)
2. BE = fixed cost/(1-(variable cost/sales))
3. graph-BE is where total cost line crosses the revenue (sales) line
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Factor pricing method
traditional method, markup method
1. 100/food cost percentage = mark-up factor
2. mark-up factor x raw food cost = selling price
3. "hidden cost" of 10% may be added to food cost to cover unproductive costs (losses in preparation, cooking, serving, unavoidable waste)
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Prime cost method
(raw food cost + labor cost involved in making the item)
1. determine prime cost: raw food cost + labor cost
2. determine price factor (markup)
--add desired food cost percentage to percentage of direct labor cost
--divide total into 100
3. selling price = prime cost x price factor (markup factor)
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promotions pricing
done for a short time
--sale or special price is done to increase sales during a slow period
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loss leaders
items priced lower to draw people in in the hope that they will purchase other items at normal markups
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cost of profit pricing
1. price the product to ensure a predetermined percentage of profit
2. profit is established as a cost
3. Add up all costs (including profit cost) as percentages.
To find the targeted food cost percentage, subtract total from 100%
To determine selling price of the item: total food cost/desired food cost percentage
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Public relations
1. Good press relations, lobbying
2. Create and place newsworthy information to attract attention
3. Build and retain relations with legislators and government officials
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Accreditation organizations
certify, manage and promote quality improvement
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DNV GL Healthcare accreditation program
validates Medicare compliance
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TJC
The Joint Commission
accredits and certifies healthcare organizations
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CMS
Centers for Medicare and Medicaid Services
1. Medicare: health insurance program for people over 65; of any age with ESRD, employers and employees pay
--Part A: hospital inpatient stays under PPS (Prospective Payment System) using predetermined rates for hospital discharges
--Part B: optional insurance for supplementary benefits
2. Medicaid: federal law administered by states, payment for medical care for all eligible needy: all ages, blind, disabled, dependent children
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A Wellness Visit (AWV)
provided by ACA (Affordable Care Act) to Medicare beneficiaries. RDNs are listed as an eligible medical professional who may screen and counsel Medicare beneficiaries
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IBT (Intensive Behavioral Therapy)
benefit for obese under Medicare Part B. Coverage is granted only in primary care setting, BMI must be >30, continued treatment contingent on weight loss assessed at the seventh month of treatment. Can only be provided by a physician
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ACA Patient Protection and Affordable Care Act
opportunities to provide MNT under benefit category "Preventative and Wellness Services"
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CHIP Children's Health Insurance Program
under the Social Security Act
a partnership between federal and state governments expanding health coverage to uninsured children whose families earn too much income to qualify for Medicaid but too little to afford private coverage
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PCMH Patient Centered Medical Home
focuses on the relationship between the patient and their personal physician. the physician takes responsibility for all aspects of the health care for the patient and coordinates and communicates with other providers as needed. If specialty care is needed, the physician is responsible for ensuring that the transition is seamless. The RDN should be considered part of the medical home treatment plan
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ACO Accountable Care Organization
a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the US are formed from a group of coordinated health-care practitioners
175
Alternative Payment Model (APM)
a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, oor a population. Ex Fee-for-Service
176
ICD-10-CM International Classification of Diseases 10th Revision, Clinical Modification
describes an individual's disease or medical condition
--codes for malnutrition E43-E46
177
CPT Codes Current Procedural Terminology
five digits that describe the services rendered. MNT codes 97802, 97803, 97804 are used to report RDN provided services
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CMS 1500 form
submit non-institutional claims to Medicare/Medicaid for healthcare services
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Cost benefit studies
determines whether the goal of the intervention is worthwhile in terms of cost. the value of the benefits derived from the intervention must outweigh the costs of providing the intervention
180
Cost effectiveness analysis
assumes that the goal of the project is worthwhile. the question to resolve is which method of intervention is the most effective (in terms of value) in achieving the goal. It compares costs of alternative strategies using the results of outcomes research
181
Audit
formal study that retrospectively monitors performance. Did performance meet the standards?
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TQM Total Quality Management; PDCA cycle (plan, do, check, act) or PDSA (plan, do, study, act)
1. problem solving technique for coordinating process improvement
2. Continuous Quality Improvement (CQI)-integral part of TQM
--ideal that systems and performance can always improve
--not an end point in quality efforts, uses outcome assessment
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Indicators
measurement tools that monitor and evaluate important aspects of patient care and management functions
1. serve as flags to direct attention to specific issues. Not intended to be direct measures of quality, but describe events, complications or outcomes
2. thresholds for evaluation (% numbers): level at which a stimulus is strong enough to signal need to respond; then begin process to determine why threshold was crossed
184
Rate-based indicator (comparative rate indicator)
1. what will happen with the BEST care, thresholds between 1% and 99%
2. 95% high-risk patients are assessed within 24 hours
3. 95% of trays are delivered into patient's room within 10 minutes of arrival on floor
185
Sentinel event indicator
a serious event that requires further investigation each time it occurs; undesirable, but avoidable events
1. threshold of either 0% or 100% (never or always)
2. 0% food poisoning; Dish-machine area floor is dry 100%
3. 100% oncology patient are feed within 5 days
186
Outcome management systems
evaluate effectiveness and efficiency
1. Effectiveness refers to the degree to which an exchange helps to achieve your objectives. (Doing the right thing)
2. Efficiency refers to the minimization of resources you must spend to achieve that desired level of exchange (doing things right)
3. Data is collected and analyzed in a timely manner so that performance can be adjusted and improved
4. Findings are compared with past levels of performance and other standards or benchmarks of optimal performance
5. Goal is to improve the quality of services offered
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Six Sigma
data-driven approach for improving quality by removing defects and their causes.
Sigma=standard deviation
Six sigma= there is very little variation in a process
Helps organizations focus on developing and delivering near-perfect products and services
If you can determine how many errors occur in a process, you can systematically determine how to eliminate them and get as close to zero as possible.
DIMAC approach: define, measure, analyze, improve, control
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Kaizen philosophy
"good change"
suggests making continuous and small incremental improvements in process on a daily basis, rather than large revolutionary changes. It focuses on teamwork, discipline, improved morale, quality circles and suggestions for improvements
189
Lean method
use less human effort, less space, less capital and less time to make products exactly as the customers want with few defects. Use videotaping and stopwatches to capture work being done. reorganize workflow, duties and practices. Reduce food costs, increase efficiency and customer satifaction
190
SOP Standards of Practice in Nutrition Care
describes in general terms a competent level of nutrition care practice as shown by the NCP. For those working in direct patient care
--standards include diabetes care, oncology nutrition care, behavioral health care, nutrition support, management of food and nutrition systems, sports dietetics, and education of dietetics practitioners, pediatric nutrition, and nephrology care
191
SOPP Standards of Professional Performance
describes a competent level of behavior in the professional role (6 domains of professionalism)
1. Provision of Services
2. Application of Research
3. Communication and Application of Knowledge
4. Utilization and Management of Resources
5. Quality in Practice
6. Competency and Accountability
192
AND Code of Ethics
1. Non-maleficence: competence and professional development in practice: intent to not inflict harm
2. Autonomy: integrity in personal and organizational behaviors and practice
3. Beneficence: Professionalism: take positive steps to benefit others
4. Justice: supports fair, equitable and appropriate treatment for individuals and fair allocation of resources
